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Tests and Screenings Shine a Spotlight on Heart Disease

Within the microscopic ribbons of veins and arteries that course throughout our body, and the layers of tissue and muscle that comprise our heart, cardiovascular disease has many places to hide and can often go unnoticed. Symptoms like fatigue and aches and pains can be “explained away” or be completely silent.

Chronic conditions – like hypertension, hardening of the arteries, congestive heart failure, irregular heartbeats - or traumatic events – like heart attack or cardiac arrest – can have significant impact on heart functions and others throughout the body.

Tests & Screenings

Several tests are used to diagnose heart disease. Your doctor will decide which are most appropriate based on your risk factors, history of heart problems or current symptoms.

Cardiac catheterization is performed to further evaluate coronary artery disease, valvular heart disease, congestive heart failure, and/or certain congenital (present at birth) heart conditions, such as atrial septal defect or ventricular septal defect, when other less invasive types of diagnostic tests indicate the presence of one of these conditions. A very small hollow tube, or catheter, is advanced from a blood vessel in the groin or arm through the aorta into the heart. Once the catheter is in place, several diagnostic techniques may be used. The tip of the catheter can be placed into various parts of the heart to measure the pressures within the chambers. The catheter can be advanced into the coronary arteries and a contrast dye injected into the arteries.

Intravascular ultrasound (IVUS) uses a computer and transducer that sends out ultrasonic sound waves to create images of the blood vessels, may be used during a cardiac cath. The use of IVUS provides direct visualization and measurement of the inside of the blood vessels and may assist the doctor in selecting the appropriate treatment needed in each particular situation. A small sample of heart tissue (called a biopsy) may be obtained during the procedure to be examined later under the microscope for abnormalities.

Ultrafast computed tomography. This CT scan produces images very rapidly, for a type of "movie" of moving parts of the body, such as the chambers and valves of the heart. This scan may also be used to obtain information about calcium build-up inside the coronary arteries of the heart.

Computed tomographic angiography (CTA) - or arteriography - is an X-ray image of the blood vessels. A CT angiogram uses CT technology rather than standard X-rays or fluoroscopy to obtain images of blood vessels, for example, the coronary arteries of the heart.

Combined computed tomography and positron emission tomography (PET/CT). PET/CT combines the ability of CT to provide detailed anatomy with the ability of PET to show cell function and metabolism to offer greater accuracy in the diagnosis and treatment of certain types of diseases, including coronary artery disease.

Cardiac CT scan can diagnose calcium deposits in the arteries before symptoms occur. Results are provided as a numerical score. While a high score doesn’t necessarily “predict” having a heart attack, it does provide an absolute diagnosis of heart disease. A calcium score, along with conventional testing and other risk indicators, presents an overall picture of heart health and is valuable information to share with your physician.

Nuclear Stress Test provides information about your heart’s ability to deal with an increased need for blood and oxygen, which occurs during exercise. During this test, an electrocardiogram (ECG) records electrical activity while the patient exercises on a treadmill or during the infusion of a stress agent. (Also known as Cardiolite Stress Test, Persantine Stress Test, Adenosine Stress Test, Dobutamine Stress Test, Myocardial Perfusion Scan, or an exercise or Pharmacological Stress Test.)

Magnetic Resonance Imaging (MRI) Diagnostic procedure that uses a combination of a large magnet, radiofrequencies, and a computer to produce detailed images of the heart, and other organs and structures within the body.

Chest X-ray

Electrocardiogram (ECG or EKG). An electrocardiogram measures electrical activity of the heart. An ECG can indicate the presence of heart rhythm disorders, damage to the heart caused by ischemia (lack of oxygen to the heart muscle) or heart attack, valves issues, or other types of heart conditions. ECGs come in many forms, including

Resting ECG. For this procedure, the clothing on the upper body is removed and small sticky patches called electrodes are attached to the chest, arms, and legs. These electrodes are connected to the ECG machine by wires. The ECG machine is then started and records the heart's electrical activity for a minute or so. The patient is lying down during this ECG.

Exercise ECG, or stress test. The patient is attached to the ECG machine as and exercises by walking on a treadmill or pedaling a stationary bicycle while the heart’s electrical activity is recorded.

Signal-averaged ECG. This procedure is done in the same manner as a resting ECG, except that the heart's electrical activity is recorded over a longer period of time, usually 15 to 20 minutes. Signal-averaged ECGs are done when arrhythmia is suspected but not seen on a resting ECG.

Electrophysiologic study (EPS). A test in which a small, thin tube (catheter) is inserted in a large blood vessel in the leg or arm and advanced to the heart to find the location misfiring electrical activity. Finding the arrhythmia site helps determine the best way to treat the irregular heartbeats.

Holter monitor. A continuous ECG recording done over a period of 24 or more hours. The patient goes about his or her usual daily activities (except for showering, swimming, or any activity causing an excessive amount of sweating) during this procedure. Holter monitoring may be done when an arrhythmia is suspected but not seen on a resting ECG.

Event monitor. Similar to a Holter monitor, but the ECG is recorded only when the patient starts the recording when symptoms are felt. Event monitors are typically worn longer than Holter monitors. The monitor can be removed to allow for showering or bathing.

Mobile cardiac monitoring. Similar to both a Holter and event monitor. The ECG is monitored constantly to allow for detection of arrhythmias, which are recorded and sent to your doctor regardless of whether symptoms are experienced. Recordings can also be initiated by the patient when symptoms are felt. These monitors can be worn up to 30 days.